ADA: Mixed Results With Diabetes Alert Dogs

Canines are beloved but yield high false-positive rate for sniffing out hypoglycemia

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Man's best friend may not the best gauge of hypoglycemic events, according to study presented here on the value of diabetes alert dogs.

Note that the rate of dog alerts during hypoglycemia were 3.2 times greater than during euglycemia, however, the first sign of hypoglycemia was the continuous glucose monitoring followed by the dog, followed by a patient's symptoms.

NEW ORLEANS -- Man's best friend may not the best gauge of hypoglycemic events, according to study presented here on the value of diabetes alert dogs.

Both the sensitivity and positive predictive value (PPV) of dog alerts were low, reported Evan Los, MD, of Oregon Health & Science University in Portland, and colleagues. When the trained dog issued an alert to a hypoglycemic event in a patient with type 1 diabetes, these alerts were only "timely" -- defined as within 10 minutes before or up to 30 minutes after a diabetic event -- a little over a third of the time (36%).

When comparing dog alerts with continuous glucose monitoring (CGM), of the 30 hypoglycemic events detected by both the CGM and the dog, the CGM alerted to these events by a clinically significant median of 22 minutes ahead of the dog. The CGM detected the threshold for hypoglycemia 73% of the time, they said in a presentation at the American Diabetes Association annual meeting.

In addition, because of inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. The false-positive rate was high -- dogs that alerted 16-20 times a week led to a mean false positive rate of 14.5 times per week, the authors reported.

Diabetes alert dogs undergo rigorous training, starting with obedience and socialization, as well as scent training. For the latter, they are trained based on a cotton swab of sweat from a human companion during a hypoglycemic event. The training takes 6-24 months to complete, but there is no universal competence test for dogs.

This is the first controlled study of the reliability of diabetes alert dogs to hypoglycemia in their diabetic companions under real-life conditions, Los said. His group examined eight patients (the youngest was 4-years-old) who had both a diabetes alert dog and a blinded CGM. Dog alerts were recorded in a diary and those were compared to capillary blood glucose (CBG) and CGM downloads.

While the dogs' performance compared with CGM was lackluster, their human companions reported being happy with their performance. Dog owners self-reported as very satisfied (8.9 of 10 on a Likert scale) and largely confident (7.9 of 10) in their dog's ability to detect hypoglycemia. The latter was cited by the study participants as the reason for having a diabetes alert dog.

The rate of dog alerts during hypoglycemia were 3.2 times greater (95% CI 2.0-5.2) than during euglycemia. However, the first sign of hypoglycemia was the CGM (70%), followed by the dog (19%), followed by a patient's symptoms (12%).

Study limitations included the small sample size, short duration of the study, and the fact that the dogs were different breeds and different ages, and from different trainers. The most reliable dog in the sample had completed 24 months of dog training, suggesting that dog skills diminish over time and may require re-training.

Los said that if someone has an alert dog and finds it beneficial, he wouldn't tell them to get rid of the animal because it is identifying more hypoglycemia than not having a dog at all.

"This is not the final word on whether trained dogs might be helpful for patients with diabetes," Los told MedPage Today. "There may be other benefits not assessed by this study that are important such as having a positive partner in the daily management of a chronic disease."

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.